A 42-year-old male presents with a deformed foot and draining sinuses. The patient is a native of Mexico, where he does manual labor. He noted the onset of persistent swelling 2 years earlier in Mexico after dropping a heavy wooden box on his foot. He received various treatments, but his foot has become more deformed. He is visiting family in the United States and comes to you for advice.
He is afebrile, with normal vital signs. He looks well. His exam is normal except for his left foot, which is swollen and firmly indurated, particularly over the metatarsals, but not very tender. Several draining sinuses are present.
His routine lab work, including CBC, is normal. An x-ray of his foot shows soft tissue defects without bony erosions.
The appropriate approach would be:
A. An empiric course of trimethoprim-sulfamethoxazole
B. An empiric course of amphotericin
C. An empiric course of itraconazole
D. Smear and culture of the sinus discharge before initiating therapy
E. Surgical biopsy and culture of deep tissue
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